20021591 Ver 1_Certification of Completion_20150218

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NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Programs
Pat McCrory Thomas A Reeder John E, Skvarla, III
Governor Director Secretary
DWR Project No. Z 5-11 County: y ��7 l,Q
Applicant: J �t c (!2, A g—N, !=
Project Name: A-,/L1 A.C.
401 Water Quality Certification Issued Date:
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer
Rules, and any subsequent modifications, the applicant is required to return this certificate to the DWR
401 & Buffer Permitting Unit, 1650 Mail Service Center, Raleigh, NC, 27699 -1650 This form may be
returned to DWR by the applicant, the applicant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these
AP liic cants Certification
1, ' LCA rl�o hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved pl ad specifications, and other supporting materials.
Signatur \d- ---1 Date:
Agent's Certfflcation
1, hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature:
Date:
if this project was designed by a Certified Professional
1, as a duly registered Professional
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been auth(oriized to
observe (periodically, weekly, full time) the construction of the project, for the Permitee hereby state that,
to the best of my abilities, due care and diligence was used in the observation of the construction such
that the construction was observed to be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting
materials.
Signature:
401 8 Buffer Pemutiaig Una
1650 Mad Samoa Center, Raleigh, North Carolina 27699 -1650
L=bon 512 N Salsbury St Raleigh, North Carolina 27604
Prom 919-807{3001 FAX [phone]
Internet wm nmiorouar,N Oro
An Equal Oppoilumty 1 Alfimiab" Action Emploly
Date:
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